蛛网膜下腔炎症的强度与细菌性脑膜炎急性期和慢性期血管壁重塑的演变相一致

Q4 Immunology and Microbiology Clinical and Experimental Neuroimmunology Pub Date : 2024-07-07 DOI:10.1111/cen3.12794
Vivig Shantha Kumar, Vignarth Shantha Kumar, Ruthvik Thaghalli Sunil Kumar
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引用次数: 0

摘要

急性细菌性脑膜炎的脑血管改变是造成患者不良后果的重要原因,据报道,并发症发生率为 10%至 29%。导致血管收缩的动脉管腔局灶性改变在细菌性脑膜炎等脑缺血和炎症性疾病中很常见,可引起神经系统并发症,如癫痫发作、脑肿胀、脑积水、听力下降以及缺血性或出血性脑损伤。在脑膜炎期间观察到的动脉狭窄可归因于多种因素,包括炎性渗出物的直接侵蚀、血管壁水肿、血管痉挛以及细胞浸润和血管重塑导致的血管炎。早期收缩可能是由于水样渗出物的侵蚀,而持续的炎症会导致渗出物变厚,吸引炎症细胞并诱导动脉病变生长因子的合成。这一过程会促进血管壁结构的改变,从内膜下浸润发展到内膜有机增厚,最终导致脉管炎和脑缺血风险。因此,本综述试图更清晰地描述细菌性脑膜炎期间蛛网膜下腔炎症与急性和慢性血管壁重塑之间错综复杂的关系。可以想象,了解这一病理过程有望揭示潜在的治疗途径,从而改善患者的预后,降低与细菌性脑膜炎期间脑血管并发症相关的发病率和死亡率。
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Intensity of subarachnoid space inflammation corresponds to the evolution of vessel wall remodeling during the acute and chronic phases of bacterial meningitis
Cerebrovascular alterations in acute bacterial meningitis significantly contribute to adverse patient outcomes, with reported complication rates ranging from 10% to 29%. Focal alterations in arterial lumens, leading to vasoconstriction, are common in cerebral ischemic and inflammatory conditions, such as bacterial meningitis, presenting neurological complications, such as seizures, brain swelling, hydrocephalus, hearing loss and ischemic or hemorrhagic brain damage. The observed arterial narrowing during meningitis is attributed to diverse factors, including direct encroachment by inflammatory exudate, vascular wall edema, vasospasm, and vasculitis due to cellular infiltration and vessel remodeling. Early‐stage constriction might result from a watery exudate's encroachment, whereas persistent inflammation leads to thicker exudates, attracting inflammatory cells and inducing arteriopathic growth factor synthesis. This process promotes structural modifications in the vessel wall, progressing from subintimal infiltration to organic intimal thickening, culminating in vasculitis and the risk of cerebral ischemia. Accordingly, this review seeks to more clearly delineate the intricate relationship between subarachnoid space inflammation and acute and chronic vessel wall remodeling during bacterial meningitis. Conceivably, understanding this pathological process holds promise in unveiling potential treatment avenues to improve patient outcomes, and reduced morbidity and mortality associated with cerebrovascular complications during bacterial meningitis.
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来源期刊
Clinical and Experimental Neuroimmunology
Clinical and Experimental Neuroimmunology Immunology and Microbiology-Immunology and Microbiology (miscellaneous)
CiteScore
1.60
自引率
0.00%
发文量
52
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